Post Orgasmic Illness Syndrome (POIS)

(After writing this post and registering I noticed that the forum rules specify no sexual content. I was going to stop, but I did a search and found another post about it. I hope this type of discussion won't be deemed inappropriate.)

Hi. I would like to relate my very personal story of an unusual condition that I have been plagued with. Ever since puberty I have had serious problems in the days immediately following ejaculation. My first symptom was acute back pain in the days following, at whatever age it was, perhaps around 14. After a few years it changed to an impaired cognitive condition, which I would describe as definite mental illness, in which thinking becomes very difficult, and it feels horrible in a way that can not be described. I'm sure specific neurotransmitters are depleted or something, but the cause of such a reaction is what I have never been able to understand. This has occurred following both nocturnal emissions and sexual activity. To minimize the problem I am not sexually active and try to avoid nocturnal emissions.

an example of their work:Post-Orgasmic Cognitive SymptomsDr. John Dean presented a case of a man in his mid fifties complaining of lifelong transient loss of memory and irritability that occurs after every orgasm. Otherwise the patient has no other sexual complaints, and no neurological disorders diagnosed by a neurologist. Dr. Dean considered asking the patient to masturbate and to have an orgasm whilst he was having his EEG. Dr. Charles Moser reported seeing two similar cases and forwarded an abstract by Dr. Waldinger –published in J Sex Marital Therapy- describing a post-ejaculatory syndrome in two men with spontaneous ejaculations. The syndrome consists of severe fatigue, intense warmth, and a flu like state, with generalized myalgia.

Dr. David Rabinowitz advised a full battery of investigations, and raised the possibility of a dissociative state, or a variant of Transient Global Amnesia. Dr. Ganesh Adaikan forwarded an article from the lancet where a woman with similar symptoms was cured with the antiepileptic, carbamazepine. Dr. Broderick also advised ruling out arrhythmias and blood pressure disorders by an ambulatory halter monitor and Blood Pressure cuff, then proceeding with considering dissociative states.

I have the same problem. I contacted Dr Waldinger and he told me that Post-Orgasmic Illness Syndrome is characterized by a general myalgia (that i don't have, only knee pains sometimes). Anyway most cases of POIS are about 40-50 years old. The auto-immmune hypothesis is possible(after orgasm the body release something and fight against it, as it was a virus or stranger => severe sweets, severe tiredness... )

EDIT 2011 : Some of my posts are obsolete after 2nd and 3rd paper of M.Waldinger. The auto-allergic hyposthesis was the good one. But we keep one eye on hormones theory because some of us have succes with testsosterone for example.

Quote

Tired and sweaty after sex? A Dutch doctor said on Friday he is studying a rare new syndrome among middle-aged men who complain of flu-like symptoms for up to a week after having an orgasm.

Marcel Waldinger, head of the department of psychiatry and neurosexology at Leyenburg Hospital in the Hague said he planned to publish a report on "post-orgasmic illness syndrome" in the US Journal of Sex and Marital Therapy this month. Waldinger has seen five Dutch men in as many years in his surgery complaining of a range of flu-like symptoms, including a sore throat, sweating, extreme fatigue and eye irritation after sex.

"Men developed influenza-like symptoms within minutes of having an orgasm. It is like having a serious flu. This happens as soon as they have an orgasm," said Waldinger. "It is a new syndrome or a syndrome which is old but has not been looked at properly." The syndrome could be a physical disorder caused by an allergic reaction or the immune system in direct response to the release of chemicals in the body after sex. The symptoms lasted between three and seven days, he said. "We know that during orgasm and ejaculation very specific compounds like hormones are released into the nervous system. One hypothesis is that they might have had an allergic reaction to one of those compounds," Waldinger said.

We describe the symptoms of a postejaculatory syndrome in two men with spontaneous ejaculations. The syndrome consists of severe fatigue, intense warmth, and a flulike state, with generalized myalgia. These symptoms occur rapidly after ejaculation and only disappear after 4 to 7 days. The symptoms are so severe that sexual activity is avoided. The cluster of symptoms is named postorgasmic illness syndrome (POIS). To date, no explanation has been offered for the etiology and pathogenesis of the symptoms, and the prevalence is unknown. Both cases are presented to draw attention to this syndrome for further research regarding etiology, pathogenesis, and treatment.

Dr. Mulhall presented a case of a 48 year old man complaining of crashing upon ejaculation for 2 days. He feels flu like symptoms, extremely achy, heavy, very sluggish cognitively, and sometimes even sore throat. He avoids ejaculation. Apart from that he is cardiac free with normal testosterone and cortisol. He suffers from hypothyroidism. His libido is normal.Dr. Mulhall found nothing in literature except a single paper (case report on 2 patients) by Dr. Marcel Waldinger and hence was asking about any ideas as regards the pathophysiology and management of this problem.Dr. Kevan tried for such cases a number of analgesics including gabapentin and pregabalin as well as many of the classic treatments for 'prostatitis'. Distraction techniques and other non ejaculatory (but orgasmic) Taoist type sexual activity, he thought might be useful. He also added that for some cultures and many couples, there are a number of psychosomatic or relational factors to considered.Dr. Moser suggested success with Buproprion having anti-anxiety properties with no negative effects on sexual functioning. Dr. Ashour had success with Tramal 50mg PRN. Dr.Dave wrote about a study which tried an opioid antagonist (Naloxone ) given to a group of atheletes having similar symptoms post exercising and questioned if this syndrome could be related to endorphin deficit.Dr. Krishnamurti stated that in some countries some guys believe that loss of semen (vital fluid) causes weakness. Many of these develop post-ejaculatory symptoms to varying degrees, sometimes severe.Detailed discussion

Dear ISSM Members:

Please read below an email from a man who seems to havepost-orgasmic illness syndrome. other than a single paper(case report on 2 patients) by marcel waldinger I have notfound any other useful literature. I would value your thoughtsas to the pathophysiology and management of this problem.

"My symptoms became apparent about 8 years ago. They arevery simple really. Upon ejaculation I crash. By that Imean, completely (and I mean completely) drained of energyfor about 2 days. I feel flu-ish, extremely achy, heavy,very sluggish cognitively, sometimes even sore throat.Needless to say, I avoid ejaculation. Other than that I am(according to my doctor) a normal, healthy, 48 year old malealthough I have hypothyroidism. I just had a physical and allblood tests and heart are normal. I have had testosteroneand cortisol tested and those are normal. Also, libido isnormal."

I am currently seeing a client with the same syndrome. Irecommend contacting Marcel D. Waldinger,

He was able to give me some insights into my case. He iscurrentlyconducting another study on this topic but his results havenot beenpublished yet.Annette Owens, MD PhD

Dear John & Annette

I am currently trying to help another man with these symptoms in my andrology clinic who avoids ejaculation at all costs. To date he has tried a number of analgesics including gabapentin and pregabalin after trails of many of the classic treatments for 'prostatitis'. Other men I have treated with similar symptoms are often resistant to medical interventions.

Distraction techniques and ‘prescribing’ non-ejaculatory (but orgasmic) Taoist type sexual activity may be useful but the aftermath of loss of ejaculatory control for many of these men is too overwhelming and they cannot be persuaded to become sexually active again.Of course for some cultures and many couples there are a number of psychosomatic or relational factors to consider.Kevan.

Dear folks,I have had several patients like this as well. I have also noted that they are resistant to medical interventions. My best success is with buproprion XL, but patients often choose to discontinue it, even after it has “helped.”Take care,Charles Moser, PhD, MD, FACP

Charleswhat is the rational for Wellbutrin??Pierre Assalian

I saw this as an anxiety disorder, at least in my patient.Buproprion doeshave anti-anxiety properties (though many people do notbelieve the data)and it has no negative effects on sexual functioning. Italso tends to energize people, so I thought it might help the feelings offatigue after orgasm.

The patient was seen back 2 in weeks; he took 150 mg QD fora week then 300 mg QD for a week. He felt his fatigue was less severeafter orgasm and his girlfriend thought everything was better in theirrelationship. He was seen after another month on 300 mg a day and reported that thefatigue and other symptoms were better and were still improving, but were notyet resolved. He then decided to travel for 6 months and did not want totake the pills with him. Also of note, he broke up with his girlfriend.Pt was lost to follow-up at that point. Take care, Charles Moser

Dear All:

Is it possible to prove that this syndrome is NOT functional in etiology ? What is the scientific explanation for this symptom complex ? In this part of the world, there are millions of guys who believe that loss of semen (vital fluid) causes weakness. Many of these develop post-ejaculatory symptoms to varying degrees, sometimes severe.If there's conjecture about possible organic etiology, it has to be established unambiguously.

Sudhakar Krishnamurti

It is possible, but the patients I have seen did not seem preoccupied with semen loss or overly worried about it. They just noted this response.See reference below.Take care,

Charles Moser, PhD, MD, FACPDear Annette and alli had one case of the same symptoms who failed any treatment but what found of geat help is to use Tramadol-Tramal 50 mg as PRN thrapy.Shedeed Ashour Shedeed

Dear colleagues,The syndrome described is reminiscent of a study I recall in which physically fit volunteers were given an opioid antagonist (Naloxone I think) and then asked to exercise. Rather than experiencing the "high" well known to exercisers after an aerobic session they experienced a response similar –it seems to me- to that described in the post-ejaculatory syndrome: fatigue, anhedonia, etc. So the question: could this be a syndrome of endorphin deficit??Dave

"Composition of SemenAccording to Sandor Gardos, Ph.D, the former About Sexuality Guide, itcontains very modest quantities of the following substances...

2nd scientific study : (february2010) !http://casereports.bmj.com/content/2010/bcr.10.2009.2359.shortThank you vey much Thisisme and CCconfucius for this excellent link.Named as coital headaches but symptoms described in complete article are definitly Pois symptoms (3 days duration, cognitive, fatigue...).The information was given just some days after publication and we really enjoyed this help.

Dr. Ashworth had a case of an 18 years old male complaining of post orgasmic illness syndrome in the form of cognitive symptoms associated with anxiety and depression. Flouxetine was prescribed which had some effect with regard reducing the amount of nocturnal emissions he experiences but has had little effect regarding his other symptoms post orgasm. Dr. Moser had tried SSRI and Bupropion with limited success. Dr. Ashour suggested the trial of cymbalta or tramal. Dr. Boul thought it might be a form of General Anxiety Disorder (GAD) with the depersonalisation experienced in Panic Attacks which might be related to a past traumatic sexual experience.

I am wondering whether it would be possible to post a query on your list or if you could provide me with any further information - particularly practitioners who know something about Post-Orgasmic Illness Syndrome.

I am about to conduct a mental health assessment on an 18 year old young man who has given me prior information that he believes that he suffers from POIS. Certainly the symptoms he describes seems to fit with the examples I have just read on your forum. The symptoms he lists are as follows:

Lack of concentrationLack of cognitionDisorientationBrain fog <-- most importantAbsentmindednessConfusionShortened attention spanDepersonalizationDe-realizationExhaustion (physically and mentally)Word finding difficultiesTongue tiedInability to comprehend/retain what is readImpairment of speech and/or reasoning (forming thoughts into words)Inability to calculate numbersDepressionAnxiousness

Any advice I could give him about how to get help would be appreciated. He finds his symptoms so troublesome that he has abstained from sexual behavior including masturbation for some time and states, "If I did not have a single orgasm in the rest of my life I would be so happy."

He tells me he has seen two GPs, neither of whom had heard of the syndrome and has subsequently been prescribed Fluoxetine 20mg which has had some effect with regard reducing the amount of nocturnal emissions he experiences but has had little effect regarding his other symptoms post orgasm.

Hope you can help and best wishes, Sarah

Sarah Ashworth

I do believe POIS exists, but there is no data on what the underlying problem is or how to treat it. Many of the individuals are quite disturbed about it (understandably), but it is not clear how to help them. I have used SSRI’s to help decrease sexual urges. I have had some limited success with Bupropion. I am also interested in what others have tried.

Sincerely,

Charles Moser, PhD, MD, FACP

Dear all

Yes it exists But the symptoms vary beteen patients. I do believe its a sort of neurotransmitters depletion??? but regarding this case it points to an AD or ADHD background of the pt. Pls check and if not; trial of Dual action anti depressants may help Cymbalta 60 mg. or Tramal 50 mg PRN in very limited range.

Shedeed Ashour

Dear Sarah

The symptoms of post orgasmic illness syndrome, and the ones you describe for your young clients, sound very much like most of the symptoms of General Anxiety Disorder (GAD) with the depersonalisation experienced in Panic Attacks.

My immediate thoughts, particularly with a young inexperienced client, would be around potential past traumatic sexual experiences i.e., early masturbatory trauma - being caught in the act, being ridiculed by a partner, or abused. Indeed, it could be a form of PTSD but it would appear that there haven’t been any long term studies to identify if the episodes intensify or change. The client could also have fears of such things as losing control, sexually transmitted diseases, inadequacy, and there is also a possibility of confusion over sexual identity.

Medication for the physical symptoms will assist your client in engaging in therapy and exploring any underlying psychological issues.

I'm really happy that you posted (and others replied).I've had POIS symptoms (no myalgia)for decades! I thought testosterone injections would help, but that turned out to only work very modestly (and exacerbating the need to have sex!).

I'm lost and extremely disappointed having this problem. I don't want to curtail sex, even though I know it creates this awful 4+ days misery.

sophiecentaur : Yes you right. Without sexual activities you feel more nervous and depressed, that's why i try to have it once a month. But the exhaustion is so severe that you need to slow down the frequency.

You post is interesting. Yes, testosterone injections seems to have a low effect on our state. You talked about POIS : have you described these symptoms with a doctor ? Very very few doctors know what pois is. As i said, POIS refer to myalgia. I don't have myalgias but cleraly intense muscle tremors and nervous system agitated in the 15-20 hours following orgams and strange cold/hot sensations (ill state as POIS). Then severe fatigue and brain fog start.

Hello B_Jim!............MANY thanks for your reply, I've contacted numerous physicians, sex researchers and many others over the years with my symptoms....and I usually get blank stares..."Gee, I never heard of THAT!" Thank you, Dr. send me a bill. Sorry to be so sarcastic, but I'm beyond desperate! (I'm hunting a solution for 25+ years)

I tried to contact you, Jim_B, but I can't figure out those crazy codes to copy (I haven't a clue how I finally made it here to TNS!)

Getting in touch with Dr Waldinger has been enormously frustrating. I succeeded once, then the email kept changing.

As you asked me to note, my most recent post-orgasmic symptoms just ended, and included 4 days of extreme exhaustion, depression, foggy cognition, burning FINGERTIPS - all 10 (this has included dermatitis, numbness and heat).

JIM_B AND EVERYONE: Since I'm unable to contact you here because I can't copy those cryptic messages (UdHk?)I would love to start a correspondence: let's gang up on this crazy syndrome!!

I was somewhat pleased to discover that I wasn't the only person to suffer from this infliction. I am a 30 year old male from the UK, who has suffered from this post ejaculation depression for a number of years. The main symptoms I get include extreme tiredness, depression "brain fog" and flushing. It has ruined a number of my relationships and has further increased my depressive state. I too have tried seeking medical advice to no avail. Conversely, I am upset to see that this condition doesn't seem to be recognised. It is evidently a problem, which is more common than one might suspect. Out of interest - do those of you who suffer from this also have (clinical) depression? And do you know if any of your family members suffered from the same condition (if you are like me you probably haven't asked)!How is the medication working out by the way? Keep in touch everyone - I really feel that we need to explore this further!!

Rob, it seems to continue working (as I suspected not as good as the first time, but still significant improvement). Time will tell. The depression is there and it worsens post-org.

Rob, your problem seems like min..."blank stares" from professionals. It's because it is VERY rare (in my opinion) - I thinl Dr. Waldinger, who is the only one who seems to have studied it, said that as well.

I'M CAUTIOUSLY OPTIMISTIC! First Day of POIS (less the myalgia) symptoms, popped a Levitra again as an experimental "cure." Also recently resumed testosterone therapy (for months the lab and the doctors had me labeled as "female" (what idiocy!) so naturally my T-readings looked high when they were in fact low.

Levitra (plus testosterone?) seemed to work again! Not the total "cure" that I hoped for, but a significant reduction of POIS symptoms, including reduced recovery time.

I AM NOT A PHYSICIAN...so don't rush out and replicate my experiment...also, I have one anxious eye on the Placebo Effect, although the very encouraging thing is that this is the 3rd try, and the placebo effect normally doesn't last on repeated trials.

It would be great if anyone can shed any theoretical light on this, i.e., why does Levitra seem to work, albeit imperfectly?Perhaps it speeds up the replacement of lost sperm? Just a wild guess.

Fewer things than POIS have been as misery-making in my life. I hope, for me and others similarly afflicted, that this may be a modest breakthrough.

I also find that keeping the mind O-F-F these symptoms of POIS helps. I tend to obsess quite a bit on the symptoms, especially the dry fingertips. Wish me luck, I just started another POIS cycle this morning and I'm not taking Levitra (I'm hoping that the peak testosterone level I'm on will help). But if I don't improve by tomorrow morning I'm taking L. Again, don't copy what I do, let me be the "guinea pig" !

Hi all,Probably like the rest of you guys I surf the net periodically looking for info about POIS from which I suffer. Well done for being brave enough to post about it. I too was in touch with Dr Waldinger, including filling out a questionaire for his research but have long since lost contact with him as he doesn't reply to emails anymore. My POIS started after I had treatment for an overactive thyroid which then went underactive following radioiodine treatment - I now take thyroxine to correct my underactive thyroid. A therapist I saw managed to actualy speak to Dr Waldinger and he apparently thought the thyroid treatment could possibly have set the condition off. Does that make sense to anyone else? Dr Waldinger said my symptoms do match POIS symptoms. However, I see there seem to be quite a variety of POIS symptoms and I don't have all of them. The most frustrating aspect is the mental fog, extreme tiredness and reduced capacity to think clearly. In the beginning (10+yrs ago) this could last as much as a month after orgasm! I also had a pressure in my head that made it feel like my eyes were bulging out. Over the years it has become less severe (or at least doesn't last as long) and now it takes around a week to recover. Needless to say this has had a detrimental effect on my social life and my work. I don't get the muscle pain some people describe but I can get loose stools (used to be diarhoea but usually not that bad now) and severe sore throat though generally I don't get that so bad either now. It's mostly the tiredness and diminished mental abiity which decreases confidence when I'm affected. I haven't yet found anything that I can say reduces symptoms but have read all your commments and ideas on this with interest. Two things have helped me. The first was when I learned about Dr Waldinger's research and that there was actually a name for the condition and it was recognised (all be it by few doctors). That makes it easier to talk about and of course there's the knowledge you're not alone. One of the biggest things though has been just remembering that its not my fault I suffer from this and to recognise that I do a pretty amazing job of coping with it, incredibly frustrating as it is. I was used to being a high achiever in life, or at least academically, until POIS hit me. Naturally I get down about it as anyone would. But I also know its not my fault that I have POIS and recognising that has, for me, been an important thing. I'm not sure of the best way to make this condition of ours more widely recognised and researched but I think that is what it needs. Lets try and club together and work towards that.I'll check back here regularly and post other relevant stuff as I think of it or come across it. Thanks again for starting and contributing to this thread. I hope others who suffer POIS will find it. all the best to you guys,stay in touch

Thank you for your post. Welcome. And let's keep up the mutual effort, everyone, maybe we'll yet conquer this most annoying syndrome! It was great to see someone else come forward, maybe we'll see more.

POIS symptom abatement progress. Levitra seems to have a continuing effect. Possibly the testosterone too, but in combination. In the first day or two of symptoms, to combat lethargy: I increased my caffeine consumption (btw, I am a caffeine addict FWIW; I'm also on ADD stimulants; and I just tried a vitamin supplement that seems to work, called "5-HOUR ENERGY" available at convenience stores such as 7-11. If unavailable, their distributor can be reached at 1-888-960-9495. No, this is not a commercial LOL.

My last two ejaculations created a very strange experience for me. I became very confused and "punch drunk", similar to what has been described above. The confusion lasted 4 to 5 hours but eventually dissipated.

The first time this happened was four weeks ago, my wife thought I was having a stroke, and rushed me to the ER in a state of mental confusion. They kept me overnight for tests; CT, MRI, EEG and Holter Monitor. Nothing abnormal except my BP was sky high 156/117. I seemed to come out after 4 or 5 hours.

I didn't connect the problem with ejaculation until it happened to me again, last weekend. Both times was I was masterbating. I have never experienced anything like this before. Now I'm afraid to have intercourse with my wife and began browsing and found this. No sure what to do next.